The majority of Colorado drug treatment facilities are for-profit businesses, and according to available data from the federal government, the state ranks highest in the United States for the percentage of rehabilitation facilities owned by private for-profit companies.The most recent figures from the National Survey of Substance Abuse Treatment Services, an annual survey conducted by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) in 2005, show that 56 percent of Colorado’s 430 drug treatment facilities are private for-profit businesses, with the rest being managed by nonprofit and government entities.
The numbers are significantly different on the national level, with only 27 percent of all treatment facilities being for-profit.
One of the reasons for the contrast, Colorado advocates say, is the lack of state funding for substance abuse programs, particularly in the area of residential rehabilitation treatment, which provides patients with a place to live while receiving treatment.
“It’s a very underfunded system,” says Carmelita Muniz, director of the Colorado Association of Alcohol and Drug Service Providers, a group composed of the state’s treatment providers. “Residential is viewed as the most expensive … so you have very few opportunities for residential, especially for women and adolescents.”
Only 14 percent of Colorado treatment centers offer residential care, according to the SAMHSA survey. The number is 28 percent nationally.
Muniz also points to a 2001 study commissioned by The National Center on Addiction and Substance Abuse at Columbia University, where Colorado ranked last out of 47 responding states for substance abuse prevention, treatment, and research spending. According to the report, at the time the state dedicated .008 percent of its budget to treatment, which is approximately $548,000. The highest spending state was New York with 1.044 percent of its state budget, or $503.8 million.
“This is the most underfunded system in the nation, so when you look at how much money we invest in it and how big the problem is, yeah, you have a lot of [organizations] that are for-profit,” Muniz says.
The for-profit ventures recognize the need for such programs and offer treatment, but only to those who can afford it. In fact, in 2006, the state Alcohol and Drug Abuse Division reported that Colorado ranked fourth in the nation for the highest population needing but not getting treatment for alcohol and illicit drug abuse.
As a result of the state’s funding priorities, privately run for-profit facilities have inadvertently succeeded in becoming a majority of Colorado’s addiction service providers. One example is the Center for Dependency, Addiction and Rehabilitation (CeDAR) in Aurora, Colorado, which offers help to patients with a treatment curriculum taken from the Betty Ford Center, the Southern California rehab facility known for its celebrity patients.
“We consulted with the Betty Ford clinic to develop our programming,” says Franklin Lisnow, executive director of CeDAR, adding that CeDAR is of the same quality as the famous clinic.
Along with 12-step programs, CeDAR specializes in the psychiatric problems that coexist with addiction, Lisnow says.
Two full-time psychiatrists from the University of Colorado Department of Psychiatry staff the center. Caitlin Jenney, a spokeswoman for the university, says that no public funds go to CeDAR operations
“It’s a very beautiful place,” says Muniz, who has toured the facility and describes the “woodsy” and “calming” feel of the building, along with a wide open courtyard and surrounding cedar trees. In contrast, according to Muniz, nonprofit residential facilities are too crowded to be as calming.
But whether patients can afford the treatment is another story. CeDAR doesn’t accept insurance, and the cost of a primary 30-day program is approximately $21,000. To compare, a 21-day program at the Colorado West Regional Mental Health Center in Grand Junction, Colorado, a nonprofit facility, is $5,250 without insurance.
Lisnow contends that not accepting insurance is an important factor if treatment and business are to proceed.
“It’s becoming more and more common because insurance companies are very difficult to deal with, and more and more facilities are finding it impossible to stay in businesses if they take insurance,” says Lisnow, who claims that insurance companies don’t understand the necessity of treatment and often stall when a patient requests an extension for such help. “The top-notch facilities are private pay,” he says, including Betty Ford.
In Colorado, 53 percent of treatment facilities reported accepting private insurance, along with 66 percent for the United States as a whole.
“The bottom line for us … is just how prohibitively expensive it is for people and how desperately the state needs to help fund and subsidize substance abuse treatment,” says Christie Donner, executive director of the Colorado Criminal Justice Reform Coalition, a group of over 112 organizations that works to reform state corrections and treatment programs.
With regard to CeDAR, Donner says it’s “not even accessible for average people.”
Muniz echoes the sentiment and notes the need for affordable substance services at the state level.
“Instead of treating people, they’re incarcerating them, or instead of treating people and their families, they’re being put in foster care or up for adoption and other issues that are very costly,” Muniz says. Improving the state’s treatment program “could save the state and taxpayers money.”